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Sökning: LAR1:gu > Doktorsavhandling > (2005-2009)

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  • Abdalrahim, Maysoon S, 1962 (författare)
  • Postoperative Pain Assessment and Management: The Effects of an Educational program on Jordanian nurses’ practice, knowledge, and attitudes
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Aims: The overall aims of this thesis was describe the current nursing postoperative pain assessment and management practices in the surgical wards in Jordan and evaluate the effectiveness of implementing a ostoperative pain management (POPM) program in improving the Jordanian nurses’ POP assessment and management practices in the surgical wards. Lewin’s Force-Field Model for change provided the structure for planning for and implementing the POPM program. Method: Both qualitative and quantitative approaches were used. Qualitative content analysis inspired by the hermeneutic philosophy was used to describe the surgical nurses’ experiences in caring for patients having POP. Data were collected by interviewing 12 registered nurses working in surgical wards at four hospitals in Jordan. A retrospective quantitative design was used to collect data on the documentation system and strategies of the POP assessment and management in the surgical wards. A total of 322 patients’ records obtained from six hospitals in Jordan were audited in six-month period. The records review was performed using three audit instruments. Later, a POPM program for nurses was implemented in two surgical wards at a university hospital in Jordan. The program was evaluated by means of a quasi-experimental design with a nonequivalent control group where the control group (120 patients) and the intervention group (120 patients) were not drawn from the same population. All registered nurses (65 nurses) employed in the two surgical wards participated in the study to implement the program. First, assessment of patients’ communication about pain with nurses and their satisfaction about nurses’ intervention were assessed by means of a questionnaire. Second, the quality of nurses’ pain assessment was evaluated by comparing the attending nurses’ assessment of patients’ pain intensity rating scores with the researcher’s rating scores of the same patients. Third, a questionnaire was used to test the nurses’ knowledge of and their attitudes toward pain. Forth, the records were audited before and after the intervention. The POPM program was implemented for three months. Findings: The findings of the studies I and II formulated the foundation where the researchers can illuminate the main issues and obstacles in the process of change toward better POP management. Findings from these studies draw attention to the fact that there is an urgent need for improving POP assessment, management and documentation. The findings illustrated that the implementation of an educational program for nurses was successful. First of all, the quality communicated information about pain and pain management with patients was significantly improved. Secondly, the nurses developed the habit of assessing POP intensity using numeric rating scales, in addition to the assessment of other pain characteristics. Thirdly, the nurses improved their knowledge about POP, and their attitudes toward it were evidently changed. Finally, the nurses improved their practice in documenting patients’ pain. The patients’ records showed a significant difference in the amount and the quality of nursing documentation which reflected the fact that nurses became more aware about the importance of documentation and might also means that they change their practices toward better POP management. Discussion and Implications: The studies provide several contributions to the knowledge and understanding of the POP current management practices such as the recognition of the surgical patients suffering due to the unsatisfactory pain management routines, the impact of health institutions restraints on nurses that prohibit them from providing quality of care for patients with POP, and the need to change the current practices of nursing documentation of POP. The findings add to a growing body of literature on the benefits of implementing educational programs for nurses to improve their roles in caring for patients with POP. The findings of this thesis provide opportunities for nurses to evaluate themselves in the area of POP knowledge and management practices which may affect their caring abilities. Another implication related to nursing practice is that this study might increase the awareness of the health care professionals and the health institutions administration toward the establishment of team work to induce change with a common purpose in upgrading the quality of pain assessment and management. Managers and supervisors can facilitate the application of educational programs and incorporate with the team to move more quickly in the desired change. Implications of the study may be relevant to nursing education and in continuing education of health care institutions.
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  • Abdulle, Sahra, 1970 (författare)
  • HIV-1 infection of the central nervous system. Markers of pathogenesis and antiretroviral treatment effects
  • 2006
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Human immunodeficiency virus type 1 (HIV-1) invades the central nervous system (CNS) early in the course of infection and either directly or through opportunistic infections causes a spectrum of neurological complications. The most severe manifestation of HIV-1 CNS infection is AIDS Dementia Complex (ADC), which occurs in approximately 20% of untreated patients with AIDS. ADC is considered the result of a complex interplay between immune activation effects and viral replication in the brain, which ultimately leads to neuronal injury and death. Reliable markers to diagnose HIV-1 associated CNS injury, track disease progression, and identify patients at risk of developing ADC are lacking. Such markers would also be beneficial in evaluating the efficacy of antiretroviral treatment (ART) in the CNS, as well as to provide insights into the pathogenesis of HIV-1 CNS infection.HIV-1 elicits intrathecal cell-mediated and humoral immune activation. We found that ART effectively decreased the cerebrospinal fluid (CSF) concentrations of neopterin and beta2-microglobulin, but had little effect on the elevated IgG index. However, almost half of the patients still had slightly elevated levels of neopterin after 2 years of follow-up. Phylogenetic analyses have identified 3 distinct HIV-1 genetic groups. Group M, which is responsible for most of the global HIV-1 epidemic is further subdivided into subtypes and circulating recombinant forms (CRFs). Most of the current knowledge of HIV-1 CNS infection is based on studies of subtype B, which is predominant in the western world. However, subtypes other than subtype B are responsible for most of the epidemic outside the western world, and HIV-1 infections due to subtypes other than B are rapidly increasing across Europe. Markers of HIV-1 CNS infection such as HIV-1 RNA, neopterin, and white blood cell (WBC) count in CSF were measured and compared in patients infected with different HIV-1 subtypes. We did not find any significant subtype-specific differences in the neuromarkers evaluated in this study. Thus, subtypes do not appear to influence neuropathogenesis.Although there is no evidence of productive infection of neurons the end-result of HIV-1 CNS infection is neuronal damage and loss. We investigated the potential of CSF neurofilament (NFL), a sensitive indicator of axonal injury, as a marker of HIV-1 associated neurodegeneration. CSF NFL concentrations were higher in patients with ADC than in neuroasymptomatic patients, or patients with primary HIV-1 infection. Patients with severe ADC had higher CSF NFL levels compared to those with milder disease. CSF NFL declined with ART to the limit of detection in parallel with virological response and neurological improvement in patients suffering from ADC.Neurocognitive impairment remains a major concern in HIV-1 infection despite the success of ART. Studies on the pathogenesis, epidemiology, and the effects of ART on HIV-1 CNS infection are important to improve patient management.
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  • Abrahamsson, Erik, 1974 (författare)
  • Atom-Diatom Scattering. From Potential Energy Surfaces to Rate Constants
  • 2008
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This thesis is about the theoretical study of collisions between atoms and diatomic molecules. It might seem like a trivial problem, but in reality it is a highly complex process. Despite, or because of, their apparent simplicity, these processes are of importance for a broad area of science. The applications stretch from the study of fundamental reactions at ultracold temperatures, through the far reaches of space, to the chemistry in the Earth’s atmosphere, and combustion at extreme temperatures. High-level ab initio methods (CASSCF/CASPT2) have been used to calculate potential energy surfaces in the linear 2Π and 4Σ−, and the non-linear 4A'' symmetry for the CNO system. The coupling between the collinear 2Π and 4Σ− surfaces has been calculated with the CASSCF/RASSI method. The collinear surfaces have been interpolated using a Generalized Discrete Variable Representation method to produce potential energy surfaces as functions of the nuclear coordinates, while the global 4A'' surface has been fitted to analytical functions using many-body expansion. Time-dependent wave packet and quasiclassical trajectory calculations are presented for the O + CN reaction on the two collinear surfaces, both with and without coupling between them. Quasiclassical trajectory calculations are presented for the C + NO reaction on the 4A'' potential energy surface. The results from the calculations for the C + NO reaction are combined with previously presented results for the 2A' and 2A'' surfaces, and compared with experiments. It is seen that the new 4A'' surface significantly improves the agreement with experiments. This is the first published study of the 4A'' surface for the CNO system. Time-independent quantum mechanical methods have been used to study the inelastic collision of various atomic and molecular systems, at temperatures ranging from the ultracold to 10 000 K. Rate constants for the fine-structure excitation in the C + H and O + H collisions are presented. These collisions are of interest in astrophysics, as the results can be used to study the chemical evolution in interstellar clouds. The fundamental and very important spin-orbit relaxation of F(2P1/2) and Cl(2P1/2) atoms in a gas of H2 is investigated, and cross sections and rate constants are presented. Scattering processes at low temperatures in external electric and magnetic fields are also studied. It is shown that the spin-orbit relaxation of polar molecules in a buffer gas of He can be effectively controlled by the field strengths and the angle between the fields, at temperatures easily reached in the lab. This is the first report of the effect of crossed electric and magnetic fields on scattering processes.
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  • Abrahamsson, Therése, 1976 (författare)
  • Plasticity of the developing glutamate synapse in the hippocampus
  • 2007
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Synapses are highly plastic, i.e. they have the ability to change their signaling strength both in the short- and long-term (e.g. long-term potentiation - LTP) in response to specific patterns of activity. In the developing brain synaptic plasticity promotes activity-dependent development, whereas in the mature brain synaptic plasticity forms the basis for learning and memory. Although both development and learning involve organization and reorganization of synaptic circuits, the extent to which the plasticity behind these two phenomena uses the same mechanisms is unknown. The glutamate synapse which represents > 90 % of the brain synapses signals mainly via postsynaptic AMPA and NMDA receptors. In the developing brain, sparse synaptic activation can make the synapse lose its AMPA signaling capacity, i.e. make it AMPA silent, while LTP can reinstall the AMPA signaling (unsilencing). The aim of this study was to investigate the possible role of the AMPA silent synapse, and its unsilencing, in developmental and mature synaptic plasticity. Electrophysiological recordings of synaptic transmission in the CA1 region and in the dentate gyrus of acute hippocampal slices were used for these studies. A new and unexpected finding was that AMPA unsilencing can also be induced by not activating the AMPA silent synapse for tens of minutes. Together with previous findings this suggests a model in which the glutamate synapse is born with a single AMPA labile module, i.e. the synapse cycles between an AMPA silent state, induced by sparse synaptic activity, and an AMPA signaling state, induced by the absence of synaptic activity. The results further suggest that AMPA silencing is a prerequisite for developmental LTP to occur. In other words, developmental LTP does not potentiate synaptic transmission but rather stabilizes the AMPA labile module. It can, however, transiently potentiate the synapse by the addition of a labile AMPA module to an existing synapse with a single stable AMPA module. After this initial period of synaptic stabilization there is an increase in synaptic connectivity between pre- and postsynaptic neurons. It is proposed that this increased connectivity can be explained, at least partly, by the addition of stable AMPA modules to existing synapses promoted by mature LTP. This thesis thus proposes that, using the same principle mechanism, namely the addition of stable AMPA modules, developmental LTP promotes initial synaptic stabilization while mature LTP promotes synaptic growth.
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  • Adamovic, Svetlana, 1965 (författare)
  • Genetic linkage and association studies in celiac disease: discoveries from whole genome analysis
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Celiac Disease (CD) or Gluten Sensitive Enteropathy (GSE) is a life-long disorder. It is characterized by inflammation in the small intestine of genetically predisposed individuals caused by inappropriate immune response to gluten, a protein enriched in some of our common grains (wheat, rye and barley). The toxicity of gluten is manifested by the autoimmune action of T-lymphocytes on mucosal cells in the small intestine, disrupting its vital function of absorbing nutrients from the food. The disease affects predominantly children, but it can develop later in life as well. Untreated CD involves risk for major complications: Dermatitis herpetiformis (“the celiac disease of the skin”), nutritional deficiencies, osteoporosis, anaemia, fertility problems, neurological disturbances and malignancies. The only known treatment for CD is a lifelong adherence to gluten-free diet (GFD). In a Scandinavian genome wide scan, performed by our group and published in 2001, eight chromosomal regions apart from HLA showed nominal significance (p < 0,05), among them 5q31-33. This region was previously suggested as a susceptibility region in other complex diseases: asthma, type 1 diabetes, rheumatoid arthritis and inflammatory bowel disease. The main goal of this study was to explore the region of 18cM on 5q31-33, identify genetic risk factors and evaluate their contribution to the development of CD. In 2003 a joint analysis of four independent genome scans was performed by the European Genetics Cluster on Coeliac Disease, a collaborative work between six European research groups, including our. Data from Italian, Finnish, UK and Swedish/Norwegian cohorts, a total of 442 families, was pooled together and analysed. The meta-analysis using pooled data confirmed 5q31-33 as the second most significant region after the HLA region. After the meta-analysis, we applied a fine mapping strategy on the 18cM region on 5q31-33. The most essential result of this study was the strengthened linkage signal on 5q31-33 In 2006 we used the Illumina platform (GoldenGate assay technology) to perform an extensive screen of the region on 5q31-33. This study identified seven associated regions within 5q31-33 and a number of associated haplotypes but none of the association signals could explain the linkage peak observed in the families previously. In 2007 we performed a follow-up study of the association to the region comprising IL2/IL21 genes on 4q27, reported in the first genome-wide association study (GWAS) in celiac cases and controls. We confirmed that the IL2/IL21 region is a susceptibility region in CD. Unfortunately, the first GWAS failed to identify specific genes predisposing to CD. The GWAS as well as our own fine mapping study pointed out the difficulties scientists face in searching for the causing variants in complex diseases. It appears that causing variants may be hard to detect with association analysis alone because of the strong linkage disequilibrium in associated regions. However, the GWAS detected a number of CD associated genomic regions which remain to be explored.
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